What is presbycusis?

Presbycusis is a gradual decline in hearing as we get older. It is one of the most common conditions of elderly adults, affecting about half of adults over the age of 75. However, the process of presbycusis can begin as early as 30-40 years old.

What causes presbycusis?

Pesbycusis is caused by the normal aging process. Aging can change the functionality of the inner ear and connections from the inner ear to the brain leading to a hearing loss.

Presbycusis most often occurs in both ears equally. It can be difficult to distinguish between presbycusis and other causes of hearing loss, such as noise-induced hearing loss or medications that are toxic to the ears (ototoxicity).

There are four main types of presbycusis based on four sites of aging in the inner ear (cochlea):

Sensory presbycusis – changes in the microscopic hair cells and supporting cells within the cochlea.

Neural presbycusis – changes in the nerve cells of the inner ear and nerve pathways that extend from the ear to the brain.

Metabolic presbycusis – changes in the stria vascularis of the cochlea which is responsible for the chemical balance of the inner ear.

Mechanical presbycusis – a thickening and stiffening of the membrane of the cochlea.

Presbycusis rarely occurs at only one of these sites exclusively, and typically involves simultaneous changes at two or more of these sites.

What are the symptoms?

The main symptom of presbycusis is a very gradual loss of hearing in both ears with a decreased ability to discriminate speech. Tinnitus may also occur.

Presbycusis may be hard to detect at first, since the hearing loss is so gradual. Here are some signs that you may have presbycusis.

You have difficulty hearing or understanding the television or when talking on the telephone.

You have difficulty following conversation in large groups or noisy environments.

You misunderstand what other people are saying or you have to ask them to repeat themselves.

Your spouse or loved ones complain that you have difficulty hearing.

How is presbycusis diagnosed?

Presbycusis is diagnosed by a hearing healthcare professional, either an otolryngologist (ENT) or an Audiologist, following a comprehensive evaluation of your hearing. There is no specific test to determine whether the hearing loss is solely presbycusis or a combination of hearing loss types (i.e. age-related hearing loss AND noise-induced hearing loss).

How is it treated?

Presbycusis is a permanent hearing loss and in most cases it cannot be medically or surgically corrected. It can be effectively managed with the use of hearing aids or other hearing technology.

Does presbycusis cause lasting problems?

Presbycusis, or hearing loss in general, can cause frustration, anxiety, and isolation due to difficulty following conversation. Research is also emerging that shows that hearing loss can lead to memory decline and an increased risk of falls.

If you suspect a hearing loss, it is important to have your hearing evaluated by a hearing healthcare professional.